Human African Trypanosomiasis


The disease

Human African Trypanosomiasis (HAT), also known as sleeping sickness, is an infection transmitted through the bite of tsetse flies. There are two forms of HAT depending on the parasite involved: Trypanosoma brucei gambiense, often referred to as Gambian sleeping sickness, which mainly occurs in West and Central Africa and accounts for the majority of HAT cases (~98%) and Trypanosoma brucei rhodesiense, often referred to as Rhodesian sleeping sickness, which mainly occurs in East and Southern Africa.  The main differences between these two forms of sleeping sickness as the speed in which an infected person will develop symptoms (Gambian sleeping sickness develop slowly over time, Rhodensian sleeping sickness develops rapidly), and that the rhodesian form is a zoonotic disease (can be transmitted between animals and humans) whereas the gambiense form only affects humans. Symptoms of sleeping sickness initially include headaches, fever, and joint stiffness, and in its advanced stages, psychological disorders, seizures. Treatment for the disease is available, however if treatment is not received the infected person will eventually die.

Disease control

There’s no preventive treatment such as a vaccine for HAT, so control consists either of preventing the disease from being transmitted in the first place or by treating infected people as early as possible. To stop the disease being transmitted, people need to find a way of not being bitten. As tsetse flies bite during the day, and are often found in unavoidable areas such as the river banks, the best way to prevent disease transmission is to reduce the number of tsetse i.e. vector control. This is most often done using insecticide treated targets (e.g. tiny targets) and insecticide-treated infected livestock, with the choice of method being dependent on the tsetse species being targeted, whereas aerial/ground spraying or habitat clearance are much less common.

HATmap_Simarro

Map of HAT foci taken from Simarro et al. (2010)

Geographical distribution

HAT is a very spatially focal disease i.e. it is only present is specific geographical areas, although the distribution of tsetse is much more widespread. Approximately 360 HAT foci or “hotspots” have been identified, most of which (300) are Gambian HAT foci, with these foci generally being found in rural and remote areas. The map on the right displays the known sleeping sickness foci (as of 2009) which have been mapped as part of the HAT Atlas project, and maps for individual countries are available here. As control improves however, the number of foci is decreasing.

Factors influencing the geographical distribution

Tsetse flies are considered to be very sensitive to environmental conditions, with the preferred conditions being dependent on the type of tsetse under consideration. Gambian HAT is mostly transmitted by riverine species, hence the flies tend to be found around rivers, whereas Rhodesian HAT is mostly transmitted by savannah species hence is more associated with forests.  Further as the rhodesiense form is zoonotic, the distribution of risk is also affected by the presence of the animal reservoir e.g. cattle.

Spatial models of the geographical distribution

The spatial models associated with HAT either focus on modelling the tsetse distribution or the distribution of cases. Factors included in these models are dependent on the species of tsetse fly or the form of HAT under consideration. There are few spatial models of tsetse in the literature, largely due to a lack of spatially referenced tsetse data. Models of tsetse that focus on understanding the geographical factors influencing the spatial distribution tend to focus on characteristics such as temperature, distance to water sources (species dependent), presence of animal reservoirs, land cover, soil moisture and vegetation measures. Measures of habitat fragmentation (the break up of habitat into smaller fragments) have also been considered as a predictor for tsetse, where fragmentation is considered to have a negative impact on tsetse transmitting both forms of the disease.

Factors affecting the spatial distribution of disease are theoretically more complex, as human mobility plays a role as people move in and out of areas inhabited by infected tsetse or infected animal reservoirs  This is difficult to account for however, and generally the proximity to high risk areas (as defined by the factors influence tsetse distribution listed above) is used as a proxy. At present, little is understood about the spatial distribution of cases in relation to the distribution of flies.

Focus of the FOCAL-NTDs project

The overall objective of the FOCAL-NTDs project is to assist in producing detailed information on tsetse fly distribution and abundance for areas that either currently are being controlled using tiny targets, or where tiny target deployment is planned for the future. This work is being undertaken in collaboration with Professor Steve Torr in connection with the Bill and Melinda Gates Foundation funded tiny targets project.

 

References

  • [DOI] Acup Christine, Bardosh Kevin Louis, Picozzi Kim, Waiswa Charles, Welburn Susan Christina. Factors Influencing Passive Surveillance for T. b. rhodesiense Human African Trypanosomiasis in Uganda.. Acta tropica 2016.
    [Bibtex]
    @article{Acup2016,
    abstract = {INTRODUCTION: Sleeping sickness or Human African Trypanosomiasis (HAT) is a neglected tropical disease of public health importance across much of Sub-Saharan Africa. In Uganda, chronic T. b. gambiense HAT (gHAT) and acute T. b. rhodesiense HAT (rHAT) occur in two large but discrete geographical foci. Both forms are difficult to diagnose, expensive to treat and ultimately fatal in the absence of treatment. The area affected by zoonotic rHAT has been steadily expanding, placing a high burden on local health systems. HAT is a disease of neglected populations and is notorious for being under-reported. Here we examine the factors that influence passive rHAT surveillance within the district health system in four Ugandan districts into which the disease had recently been introduced, focusing on staff knowledge, infrastructure and data management.
    METHODS: A mixed methods study was undertaken between 2011 and 2013 in Dokolo, Kaberamaido, Soroti and Serere districts to explore health facility capacity and clinical service provision, diagnostic capacity, HAT knowledge and case reporting. Structured interviews were undertaken with 86 medical personnel, including clinicians, nurses, midwives and technicians across 65 HC-II and HC-III medical facilities, where the health infrastructure was also directly observed. Eleven semi-structured interviews were undertaken with medical staff in each of the three designated HAT treatment facilities (Dokolo, Lwala and Serere HC-IV) in the area. HAT treatment centre case records, collected between 2009-2012, were analyzed.
    RESULTS: Most medical staff in HC-II and HC-III facilities had been made aware of HAT from radio broadcasts, newspapers and by word of mouth, suggestive of a lack of formal training. Key knowledge as regards the causative agent, clinical signs and that HAT drugs are provided free of charge was lower amongst HC-II than HC-III staff. Many respondents did not know whether HAT was endemic in their district. In rHAT specialist treatment centres, staff were knowledgeable of HAT and were confident in their ability to diagnose and manage cases. Between 2009-2012, 342 people were diagnosed in the area, 54{\%} in the late stage of the disease. Over the period of this study the proportion of rHAT cases identified in early stage fell and by 2012 the majority of cases identified were diagnosed in the late stage.
    CONCLUSION: This study illustrates the critical role of the district health system in HAT management. The increasing proportion of cases identified at a late stage in this study indicates a major gap in lower tier levels in patient referral, diagnosis and reporting that urgently needs to be addressed. Integrating HAT diagnosis into national primary healthcare programs and providing training to medical workers at all levels is central to the new 2030 WHO HAT elimination goal. Given the zoonotic nature of rHAT, joined up active surveillance in human and animal populations in Uganda is also needed. The role of the Coordinating Office for Control of Trypanosomiasis in Uganda in implementing a One Health approach will be key to sustainable management of zoonotic HAT.},
    author = {Acup, Christine and Bardosh, Kevin Louis and Picozzi, Kim and Waiswa, Charles and Welburn, Susan Christina},
    doi = {10.1016/j.actatropica.2016.05.009},
    issn = {1873-6254},
    journal = {Acta tropica},
    month = {may},
    pmid = {27212706},
    title = {{Factors Influencing Passive Surveillance for T. b. rhodesiense Human African Trypanosomiasis in Uganda.}},
    url = {http://www.ncbi.nlm.nih.gov/pubmed/27212706},
    year = {2016}
    }
  • [DOI] Courtin Fabrice, Camara Mamadou, Rayaisse Jean-Baptiste, Kagbadouno Moise, Dama Emilie, Camara Oumou, Traoré Ibrahima S, Rouamba Jérémi, Peylhard Moana, Somda Martin B, Leno Mamadou, Lehane Mike J, Torr Steve J, Solano Philippe, Jamonneau Vincent, Bucheton Bruno. Reducing Human-Tsetse Contact Significantly Enhances the Efficacy of Sleeping Sickness Active Screening Campaigns: A Promising Result in the Context of Elimination.. Plos neglected tropical diseases 2015;9(8):e0003727.
    [Bibtex]
    @article{Courtin2015,
    abstract = {BACKGROUND: Control of gambiense sleeping sickness, a neglected tropical disease targeted for elimination by 2020, relies mainly on mass screening of populations at risk and treatment of cases. This strategy is however challenged by the existence of undetected reservoirs of parasites that contribute to the maintenance of transmission. In this study, performed in the Boffa disease focus of Guinea, we evaluated the value of adding vector control to medical surveys and measured its impact on disease burden.
    METHODS: The focus was divided into two parts (screen and treat in the western part; screen and treat plus vector control in the eastern part) separated by the Rio Pongo river. Population census and baseline entomological data were collected from the entire focus at the beginning of the study and insecticide impregnated targets were deployed on the eastern bank only. Medical surveys were performed in both areas in 2012 and 2013.
    FINDINGS: In the vector control area, there was an 80{\%} decrease in tsetse density, resulting in a significant decrease of human tsetse contacts, and a decrease of disease prevalence (from 0.3{\%} to 0.1{\%}; p=0.01), and an almost nil incidence of new infections ({\textless}0.1{\%}). In contrast, incidence was 10 times higher in the area without vector control ({\textgreater}1{\%}, p{\textless}0.0001) with a disease prevalence increasing slightly (from 0.5 to 0.7{\%}, p=0.34).
    INTERPRETATION: Combining medical and vector control was decisive in reducing T. b. gambiense transmission and in speeding up progress towards elimination. Similar strategies could be applied in other foci.},
    author = {Courtin, Fabrice and Camara, Mamadou and Rayaisse, Jean-Baptiste and Kagbadouno, Moise and Dama, Emilie and Camara, Oumou and Traor{\'{e}}, Ibrahima S and Rouamba, J{\'{e}}r{\'{e}}mi and Peylhard, Moana and Somda, Martin B and Leno, Mamadou and Lehane, Mike J and Torr, Steve J and Solano, Philippe and Jamonneau, Vincent and Bucheton, Bruno},
    doi = {10.1371/journal.pntd.0003727},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Courtin et al. - 2015 - Reducing Human-Tsetse Contact Significantly Enhances the Efficacy of Sleeping Sickness Active Screening Campaign.pdf:pdf},
    isbn = {10.1371/journal.pntd.0003727},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    month = {aug},
    number = {8},
    pages = {e0003727},
    pmid = {26267667},
    publisher = {Public Library of Science},
    title = {{Reducing Human-Tsetse Contact Significantly Enhances the Efficacy of Sleeping Sickness Active Screening Campaigns: A Promising Result in the Context of Elimination.}},
    url = {http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003727},
    volume = {9},
    year = {2015}
    }
  • Desmond-Hellmann Sue. What if… A letter from the CEO of the Bill & Melinda Gates Foundation. , 2016.
    [Bibtex]
    @misc{Desmond-Hellmann2016,
    author = {Desmond-Hellmann, Sue},
    title = {{What if... A letter from the CEO of the Bill {\&} Melinda Gates Foundation}},
    url = {http://www.gatesfoundation.org/2016/ceo-letter},
    year = {2016}
    }
  • [DOI] Dicko Ahmadou H, Percoma Lassane, Sow Adama, Adam Yahaya, Mahama Charles, Sidibé Issa, Dayo Guiguigbaza-Kossigan, Thévenon Sophie, Fonta William, Sanfo Safietou, Djiteye Aligui, Salou Ernest, Djohan Vincent, Cecchi Giuliano, Bouyer Jérémy. A Spatio-temporal Model of African Animal Trypanosomosis Risk.. Plos neglected tropical diseases 2015;9(7):e0003921.
    [Bibtex]
    @article{Dicko2015,
    abstract = {BACKGROUND: African animal trypanosomosis (AAT) is a major constraint to sustainable development of cattle farming in sub-Saharan Africa. The habitat of the tsetse fly vector is increasingly fragmented owing to demographic pressure and shifts in climate, which leads to heterogeneous risk of cyclical transmission both in space and time. In Burkina Faso and Ghana, the most important vectors are riverine species, namely Glossina palpalis gambiensis and G. tachinoides, which are more resilient to human-induced changes than the savannah and forest species. Although many authors studied the distribution of AAT risk both in space and time, spatio-temporal models allowing predictions of it are lacking.
    METHODOLOGY/PRINCIPAL FINDINGS: We used datasets generated by various projects, including two baseline surveys conducted in Burkina Faso and Ghana within PATTEC (Pan African Tsetse and Trypanosomosis Eradication Campaign) national initiatives. We computed the entomological inoculation rate (EIR) or tsetse challenge using a range of environmental data. The tsetse apparent density and their infection rate were separately estimated and subsequently combined to derive the EIR using a "one layer-one model" approach. The estimated EIR was then projected into suitable habitat. This risk index was finally validated against data on bovine trypanosomosis. It allowed a good prediction of the parasitological status (r2 = 67{\%}), showed a positive correlation but less predictive power with serological status (r2 = 22{\%}) aggregated at the village level but was not related to the illness status (r2 = 2{\%}).
    CONCLUSIONS/SIGNIFICANCE: The presented spatio-temporal model provides a fine-scale picture of the dynamics of AAT risk in sub-humid areas of West Africa. The estimated EIR was high in the proximity of rivers during the dry season and more widespread during the rainy season. The present analysis is a first step in a broader framework for an efficient risk management of climate-sensitive vector-borne diseases.},
    author = {Dicko, Ahmadou H and Percoma, Lassane and Sow, Adama and Adam, Yahaya and Mahama, Charles and Sidib{\'{e}}, Issa and Dayo, Guiguigbaza-Kossigan and Th{\'{e}}venon, Sophie and Fonta, William and Sanfo, Safietou and Djiteye, Aligui and Salou, Ernest and Djohan, Vincent and Cecchi, Giuliano and Bouyer, J{\'{e}}r{\'{e}}my},
    doi = {10.1371/journal.pntd.0003921},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Dicko et al. - 2015 - A Spatio-temporal Model of African Animal Trypanosomosis Risk.pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    month = {jul},
    number = {7},
    pages = {e0003921},
    pmid = {26154506},
    publisher = {Public Library of Science},
    title = {{A Spatio-temporal Model of African Animal Trypanosomosis Risk.}},
    url = {http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003921},
    volume = {9},
    year = {2015}
    }
  • [DOI] Franco Jose R, Simarro Pere P, Diarra Abdoulaye, Jannin Jean G. Epidemiology of human African trypanosomiasis.. Clinical epidemiology 2014;6:257-75.
    [Bibtex]
    @article{Franco2014,
    abstract = {Human African trypanosomiasis (HAT), or sleeping sickness, is caused by Trypanosoma brucei gambiense, which is a chronic form of the disease present in western and central Africa, and by Trypanosoma brucei rhodesiense, which is an acute disease located in eastern and southern Africa. The rhodesiense form is a zoonosis, with the occasional infection of humans, but in the gambiense form, the human being is regarded as the main reservoir that plays a key role in the transmission cycle of the disease. The gambiense form currently assumes that 98{\%} of the cases are declared; the Democratic Republic of the Congo is the most affected country, with more than 75{\%} of the gambiense cases declared. The epidemiology of the disease is mediated by the interaction of the parasite (trypanosome) with the vectors (tsetse flies), as well as with the human and animal hosts within a particular environment. Related to these interactions, the disease is confined in spatially limited areas called "foci", which are located in Sub-Saharan Africa, mainly in remote rural areas. The risk of contracting HAT is, therefore, determined by the possibility of contact of a human being with an infected tsetse fly. Epidemics of HAT were described at the beginning of the 20th century; intensive activities have been set up to confront the disease, and it was under control in the 1960s, with fewer than 5,000 cases reported in the whole continent. The disease resurged at the end of the 1990s, but renewed efforts from endemic countries, cooperation agencies, and nongovernmental organizations led by the World Health Organization succeeded to raise awareness and resources, while reinforcing national programs, reversing the trend of the cases reported, and bringing the disease under control again. In this context, sustainable elimination of the gambiense HAT, defined as the interruption of the transmission of the disease, was considered as a feasible target for 2030. Since rhodesiense HAT is a zoonosis, where the animal reservoir plays a key role, the interruption of the disease's transmission is not deemed feasible.},
    author = {Franco, Jose R and Simarro, Pere P and Diarra, Abdoulaye and Jannin, Jean G},
    doi = {10.2147/CLEP.S39728},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Franco et al. - 2014 - Epidemiology of human African trypanosomiasis.pdf:pdf},
    issn = {1179-1349},
    journal = {Clinical epidemiology},
    month = {jan},
    pages = {257--75},
    pmid = {25125985},
    title = {{Epidemiology of human African trypanosomiasis.}},
    url = {http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4130665{\&}tool=pmcentrez{\&}rendertype=abstract},
    volume = {6},
    year = {2014}
    }
  • [DOI] Hackett Finola, {Berrang Ford} Lea, Fèvre Eric, Simarro Pere. Incorporating scale dependence in disease burden estimates: the case of human African trypanosomiasis in Uganda.. Plos neglected tropical diseases 2014;8(2):e2704.
    [Bibtex]
    @article{Hackett2014,
    abstract = {BACKGROUND: The WHO has established the disability-adjusted life year (DALY) as a metric for measuring the burden of human disease and injury globally. However, most DALY estimates have been calculated as national totals. We mapped spatial variation in the burden of human African trypanosomiasis (HAT) in Uganda for the years 2000-2009. This represents the first geographically delimited estimation of HAT disease burden at the sub-country scale.
    METHODOLOGY/PRINCIPAL FINDINGS: Disability-adjusted life-year (DALY) totals for HAT were estimated based on modelled age and mortality distributions, mapped using Geographic Information Systems (GIS) software, and summarised by parish and district. While the national total burden of HAT is low relative to other conditions, high-impact districts in Uganda had DALY rates comparable to the national burden rates for major infectious diseases. The calculated average national DALY rate for 2000-2009 was 486.3 DALYs/100 000 persons/year, whereas three districts afflicted by rhodesiense HAT in southeastern Uganda had burden rates above 5000 DALYs/100 000 persons/year, comparable to national GBD 2004 average burden rates for malaria and HIV/AIDS.
    CONCLUSIONS/SIGNIFICANCE: These results provide updated and improved estimates of HAT burden across Uganda, taking into account sensitivity to under-reporting. Our results highlight the critical importance of spatial scale in disease burden analyses. National aggregations of disease burden have resulted in an implied bias against highly focal diseases for which geographically targeted interventions may be feasible and cost-effective. This has significant implications for the use of DALY estimates to prioritize disease interventions and inform cost-benefit analyses.},
    author = {Hackett, Finola and {Berrang Ford}, Lea and F{\`{e}}vre, Eric and Simarro, Pere},
    doi = {10.1371/journal.pntd.0002704},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hackett et al. - 2014 - Incorporating scale dependence in disease burden estimates the case of human African trypanosomiasis in Ugand(2).pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    month = {feb},
    number = {2},
    pages = {e2704},
    pmid = {24551264},
    title = {{Incorporating scale dependence in disease burden estimates: the case of human African trypanosomiasis in Uganda.}},
    url = {http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3923749{\&}tool=pmcentrez{\&}rendertype=abstract},
    volume = {8},
    year = {2014}
    }
  • [DOI] Lehane Mike, Alfaroukh Idriss, Bucheton Bruno, Camara Mamadou, Harris Angi, Kaba Dramane, Lumbala Crispin, Peka Mallaye, Rayaisse Jean-Baptiste, Waiswa Charles, Solano Philippe, Torr Steve. Tsetse Control and the Elimination of Gambian Sleeping Sickness.. Plos neglected tropical diseases 2016;10(4):e0004437.
    [Bibtex]
    @article{Lehane2016,
    author = {Lehane, Mike and Alfaroukh, Idriss and Bucheton, Bruno and Camara, Mamadou and Harris, Angi and Kaba, Dramane and Lumbala, Crispin and Peka, Mallaye and Rayaisse, Jean-Baptiste and Waiswa, Charles and Solano, Philippe and Torr, Steve},
    doi = {10.1371/journal.pntd.0004437},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Lehane et al. - 2016 - Tsetse Control and the Elimination of Gambian Sleeping Sickness.pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    month = {apr},
    number = {4},
    pages = {e0004437},
    pmid = {27128795},
    publisher = {Public Library of Science},
    title = {{Tsetse Control and the Elimination of Gambian Sleeping Sickness.}},
    url = {http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004437},
    volume = {10},
    year = {2016}
    }
  • [DOI] Lumbala Crispin, Simarro Pere P, Cecchi Giuliano, Paone Massimo, Franco José R, {Kande Betu Ku Mesu} Victor, Makabuza Jacquies, Diarra Abdoulaye, Chansy Shampa, Priotto Gerardo, Mattioli Raffaele C, Jannin Jean G. Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk.. International journal of health geographics 2015;14:20.
    [Bibtex]
    @article{Lumbala2015,
    abstract = {BACKGROUND: For the past three decades, the Democratic Republic of the Congo (DRC) has been the country reporting the highest number of cases of human African trypanosomiasis (HAT). In 2012, DRC continued to bear the heaviest burden of gambiense HAT, accounting for 84 {\%} of all cases reported at the continental level (i.e., 5,968/7,106). This paper reviews the status of sleeping sickness in DRC between 2000 and 2012, with a focus on spatio-temporal patterns. Epidemiological trends at the national and provincial level are presented.
    RESULTS: The number of HAT cases reported yearly from DRC decreased by 65 {\%} from 2000 to 2012, i.e., from 16,951 to 5,968. At the provincial level a more complex picture emerges. Whilst HAT control in the Equateur province has had a spectacular impact on the number of cases (97 {\%} reduction), the disease has proved more difficult to tackle in other provinces, most notably in Bandundu and Kasai, where, despite substantial progress, HAT remains entrenched. HAT prevalence presents its highest values in the northern part of the Province Orientale, where a number of constraints hinder surveillance and control. Significant coordinated efforts by the National Sleeping Sickness Control Programme and the World Health Organization in data collection, reporting, management and mapping, culminating in the Atlas of HAT, have enabled HAT distribution and risk in DRC to be known with more accuracy than ever before. Over 18,000 locations of epidemiological interest have been geo-referenced (average accuracy ≈ 1.7 km), corresponding to 93.6 {\%} of reported cases (period 2000-2012). The population at risk of contracting sleeping sickness has been calculated for two five-year periods (2003-2007 and 2008-2012), resulting in estimates of 33 and 37 million people respectively.
    CONCLUSIONS: The progressive decrease in HAT cases reported since 2000 in DRC is likely to reflect a real decline in disease incidence. If this result is to be sustained, and if further progress is to be made towards the goal of HAT elimination, the ongoing integration of HAT control and surveillance into the health system is to be closely monitored and evaluated, and active case-finding activities are to be maintained, especially in those areas where the risk of infection remains high and where resurgence could occur.},
    author = {Lumbala, Crispin and Simarro, Pere P and Cecchi, Giuliano and Paone, Massimo and Franco, Jos{\'{e}} R and {Kande Betu Ku Mesu}, Victor and Makabuza, Jacquies and Diarra, Abdoulaye and Chansy, Shampa and Priotto, Gerardo and Mattioli, Raffaele C and Jannin, Jean G},
    doi = {10.1186/s12942-015-0013-9},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Lumbala et al. - 2015 - Human African trypanosomiasis in the Democratic Republic of the Congo disease distribution and risk(2).pdf:pdf},
    issn = {1476-072X},
    journal = {International journal of health geographics},
    month = {jan},
    pages = {20},
    pmid = {26047813},
    title = {{Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk.}},
    url = {http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4501122{\&}tool=pmcentrez{\&}rendertype=abstract},
    volume = {14},
    year = {2015}
    }
  • [DOI] Lutumba Pascal, Matovu Enock, Boelaert Marleen. Human African Trypanosomiasis (HAT). In: Neglected tropical diseases – sub-saharan africa. , 2016, 63-85.
    [Bibtex]
    @incollection{Lutumba2016,
    author = {Lutumba, Pascal and Matovu, Enock and Boelaert, Marleen},
    booktitle = {Neglected Tropical Diseases - Sub-Saharan Africa},
    doi = {10.1007/978-3-319-25471-5_4},
    pages = {63--85},
    title = {{Human African Trypanosomiasis (HAT)}},
    url = {http://link.springer.com/10.1007/978-3-319-25471-5{\_}4},
    year = {2016}
    }
  • [DOI] Rogers DJ. Satellites, Space, Time and the African Trypanosomiasis. Advances in parasitology 2000;47:129-171.
    [Bibtex]
    @article{Rogers2000,
    abstract = {The human and animal trypanosomiases of Africa provide unique challenges to epidemiologists because of the spatial and temporal scales over which variation in transmission takes place. This chapter describes how our descriptions of the different components of transmission, from the parasites to the affected hosts, eventually developed to include geographical dimensions. It then briefly mentions two key analytical techniques used in the application of multi-temporal remotely sensed imagery to the interpretation of field data; temporal Fourier analysis for data reduction, and a variety of discriminant analytical techniques to describe the distribution and abundance of vectors and diseases. Satellite data may be used both for biological. process-based models and for statistical descriptions of vector populations and disease transmission. Examples are given of models for the tsetse Glossina morsitans in the Yankari Game Reserve, Nigeria, and in The Gambia. In both sites the satellite derived index of Land Surface Temperature (LST) is the best correlate of monthly mortality rates and is used to drive tsetse population models. The Gambia model is then supplemented with a disease transmission component; the mean infection rates of the vectors and of local cattle are satisfactorily described by the model, as are the seasonal variations of infection in the cattle. High and low spatial resolution satellite data have been used in a number of statistical studies of land cover types and tsetse habitats. In addition multi-temporal data may be related to both the incidence and prevalence of trypanosomiasis. Analysis of past and recent animal and human trypanosomiasis data from south-east Uganda supports the suggestion of the importance of cattle as a reservoir of the human disease in this area: mean infection prevalences in both human and animal hosts rise and fall in a similar fashion over the same range of increasing vegetation index values. Monthly sleeping sickness case data from the districts and counties of south-east Uganda are analysed and often show significant correlations with local LST. Case numbers increase with LST in areas that are relatively cooler than average for this part of Uganda, but decrease with LST in areas that are on average warmer. This indicates different seasonal cycles of risk across the region, and may be related to the differing vectorial roles of the two local tsetse, G. fuscipes and G. pallidipes. Finally, the increasing pace of change, and the likelihood of new or re-emerging vector-borne diseases, highlight the need for accurate and timely information on habitat changes and the impacts these will have on disease transmission. The next generation of satellites will have significantly more spectral and spatial resolution than the current satellites, and will enable us to refine both statistical and biological predictions of trypanosomiasis and other vector-borne diseases within disease early warning systems.},
    author = {Rogers, D.J.},
    doi = {10.1016/S0065-308X(00)47008-9},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Rogers - 2000 - Remote Sensing and Geographical Information Systems in Epidemiology.pdf:pdf},
    isbn = {0123335604},
    issn = {0065308X},
    journal = {Advances in Parasitology},
    pages = {129--171},
    publisher = {Elsevier},
    series = {Advances in Parasitology},
    title = {{Satellites, Space, Time and the African Trypanosomiasis}},
    url = {http://www.sciencedirect.com/science/article/pii/S0065308X00470089},
    volume = {47},
    year = {2000}
    }
  • [DOI] Sciarretta A, Tikubet Getachew, Baumgärtner J, Girma Melaku, Trematerra P. Spatial clustering and associations of two savannah tsetse species, Glossina morsitans submorsitans and Glossina pallidipes (Diptera: Glossinidae), for guiding interventions in an adaptive cattle health management framework.. Bulletin of entomological research 2010;100(6):661-70.
    [Bibtex]
    @article{Sciarretta2010,
    abstract = {The paper deals with tsetse (family Glossinidae) control and aims at improving the methodology for precision targeting interventions in an adaptive pest management system. The spatio-temporal distribution of Glossina morsitans submorsitans Newstead, and Glossina pallidipes Austen, at Ethiopia's Keto pilot site, is analyzed with the spatial analysis by distance indices (SADIE) methodology that focus on clustering and spatial associations between species and between sexes. Both species displayed an aggregated distribution characterised by two main patches in the south and an extended gap in the north. Spatial patterns were positively correlated and stable in most cases, with the exception of the early dry season and the short rainy season when there were differences between the species and sexes. For precision targeting interventions, the presented methods here are more effective than the previously used geostatistical analyses for identifying and delimiting hot spots on maps, measuring shapes and sizes of patches, and discarding areas with low tsetse density. Because of the improved knowledge on hot spot occurrences, the methods allow a better delimitation of the territory for control operations and a more precise computation of the number of the relatively expensive traps used for monitoring and control purposes.},
    author = {Sciarretta, A and Tikubet, Getachew and Baumg{\"{a}}rtner, J and Girma, Melaku and Trematerra, P},
    doi = {10.1017/S0007485309990733},
    issn = {1475-2670},
    journal = {Bulletin of entomological research},
    keywords = {Animal Husbandry,Animal Husbandry: methods,Animals,Cattle,Demography,Ecosystem,Ethiopia,Female,Male,Pest Control,Pest Control: methods,Sex Factors,Time Factors,Tsetse Flies,Tsetse Flies: physiology},
    language = {English},
    month = {dec},
    number = {6},
    pages = {661--70},
    pmid = {20504383},
    publisher = {Cambridge University Press},
    title = {{Spatial clustering and associations of two savannah tsetse species, Glossina morsitans submorsitans and Glossina pallidipes (Diptera: Glossinidae), for guiding interventions in an adaptive cattle health management framework.}},
    url = {http://journals.cambridge.org/abstract{\_}S0007485309990733},
    volume = {100},
    year = {2010}
    }
  • Sciarretta Andrea, Girma Melaku, Tikubet Getachew, Belayehun Lulseged, Ballo Shifa, Baumgärtner Johann. Development of an adaptive tsetse population management scheme for the Luke community, Ethiopia.. Journal of medical entomology 2005;42(6):1006-19.
    [Bibtex]
    @article{Sciarretta2005,
    abstract = {Since 1996, tsetse (Glossina spp.) control operations, using odor-baited traps, have been carried out in the Luke area of Gurage zone, southwestern Ethiopia. Glossina morsitans submorsitans Newstead was identified as the dominant species in the area, but the presence of Glossina fuscipes Newstead and Glossina pallidipes Austen also was recorded. Here, we refer to the combined number of these three species and report the work undertaken from October 2002 to October 2004 to render the control system more efficient by reducing the number of traps used and maintaining the previously reached levels of tsetse occurrence and trypanosomiasis prevalence. This was done by the design and implementation of an adaptive tsetse population management system. It consists first of an efficient community-participatory monitoring scheme that allowed us to reduce the number of traps used from 216 to 127 (107 monitoring traps and 20 control traps). Geostatistical methods, including kriging and mapping, furthermore allowed identification and monitoring of the spatiotemporal dynamics of patches with increased fly densities, referred to as hot spots. To respond to hot spots, the Luke community was advised and assisted in control trap deployment. Adaptive management was shown to be more efficient than the previously used mass trapping system. In that context, trap numbers could be reduced substantially, at the same time maintaining previously achieved levels of tsetse occurrences and disease prevalence.},
    author = {Sciarretta, Andrea and Girma, Melaku and Tikubet, Getachew and Belayehun, Lulseged and Ballo, Shifa and Baumg{\"{a}}rtner, Johann},
    issn = {0022-2585},
    journal = {Journal of medical entomology},
    keywords = {Animals,Cattle,Endemic Diseases,Endemic Diseases: prevention {\&} control,Ethiopia,Insect Control,Insect Control: methods,Insect Vectors,Insect Vectors: physiology,Odors,Population Density,Trypanosoma brucei brucei,Trypanosoma brucei brucei: growth {\&} development,Trypanosoma congolense,Trypanosoma congolense: growth {\&} development,Trypanosoma vivax,Trypanosoma vivax: growth {\&} development,Trypanosomiasis, African,Trypanosomiasis, African: prevention {\&} control,Tsetse Flies,Tsetse Flies: physiology},
    month = {nov},
    number = {6},
    pages = {1006--19},
    pmid = {16465742},
    title = {{Development of an adaptive tsetse population management scheme for the Luke community, Ethiopia.}},
    url = {http://www.ncbi.nlm.nih.gov/pubmed/16465742},
    volume = {42},
    year = {2005}
    }
  • [DOI] Shaw Alexandra PM, Tirados Inaki, Mangwiro Clement TN, Esterhuizen Johan, Lehane Michael J, Torr Stephen J, Kovacic Vanja. Costs of using "tiny targets" to control Glossina fuscipes fuscipes, a vector of gambiense sleeping sickness in Arua District of Uganda.. Plos neglected tropical diseases 2015;9(3):e0003624.
    [Bibtex]
    @article{Shaw2015,
    abstract = {INTRODUCTION: To evaluate the relative effectiveness of tsetse control methods, their costs need to be analysed alongside their impact on tsetse populations. Very little has been published on the costs of methods specifically targeting human African trypanosomiasis.
    METHODOLOGY/PRINCIPAL FINDINGS: In northern Uganda, a 250 km2 field trial was undertaken using small (0.5 X 0.25 m) insecticide-treated targets ("tiny targets"). Detailed cost recording accompanied every phase of the work. Costs were calculated for this operation as if managed by the Ugandan vector control services: removing purely research components of the work and applying local salaries. This calculation assumed that all resources are fully used, with no spare capacity. The full cost of the operation was assessed at USD 85.4 per km2, of which USD 55.7 or 65.2{\%} were field costs, made up of three component activities (target deployment: 34.5{\%}, trap monitoring: 10.6{\%} and target maintenance: 20.1{\%}). The remaining USD 29.7 or 34.8{\%} of the costs were for preliminary studies and administration (tsetse surveys: 6.0{\%}, sensitisation of local populations: 18.6{\%} and office support: 10.2{\%}). Targets accounted for only 12.9{\%} of the total cost, other important cost components were labour (24.1{\%}) and transport (34.6{\%}).
    DISCUSSION: Comparison with the updated cost of historical HAT vector control projects and recent estimates indicates that this work represents a major reduction in cost levels. This is attributed not just to the low unit cost of tiny targets but also to the organisation of delivery, using local labour with bicycles or motorcycles. Sensitivity analyses were undertaken, investigating key prices and assumptions. It is believed that these costs are generalizable to other HAT foci, although in more remote areas, with denser vegetation and fewer people, costs would increase, as would be the case for other tsetse control techniques.},
    author = {Shaw, Alexandra P M and Tirados, Inaki and Mangwiro, Clement T N and Esterhuizen, Johan and Lehane, Michael J and Torr, Stephen J and Kovacic, Vanja},
    doi = {10.1371/journal.pntd.0003624},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Shaw et al. - 2015 - Costs of using tiny targets to control Glossina fuscipes fuscipes, a vector of gambiense sleeping sickness in Arua.pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    keywords = {Animals,Humans,Insect Control,Insect Control: economics,Insect Vectors,Insect Vectors: drug effects,Insecticides,Insecticides: economics,Insecticides: pharmacology,Trypanosomiasis, African,Trypanosomiasis, African: prevention {\&} control,Tsetse Flies,Tsetse Flies: drug effects,Uganda},
    month = {mar},
    number = {3},
    pages = {e0003624},
    pmid = {25811956},
    publisher = {Public Library of Science},
    title = {{Costs of using "tiny targets" to control Glossina fuscipes fuscipes, a vector of gambiense sleeping sickness in Arua District of Uganda.}},
    url = {http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003624},
    volume = {9},
    year = {2015}
    }
  • [DOI] Simarro Pere P, Diarra Abdoulaye, {Ruiz Postigo} Jose A, Franco José R, Jannin Jean G. The human African trypanosomiasis control and surveillance programme of the World Health Organization 2000-2009: the way forward.. Plos neglected tropical diseases 2011;5(2):e1007.
    [Bibtex]
    @article{Simarro2011,
    author = {Simarro, Pere P and Diarra, Abdoulaye and {Ruiz Postigo}, Jose A and Franco, Jos{\'{e}} R and Jannin, Jean G},
    doi = {10.1371/journal.pntd.0001007},
    editor = {Aksoy, Serap},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    keywords = {Communicable Disease Control,Communicable Disease Control: methods,Communicable Disease Control: organization {\&} admin,Endemic Diseases,Geography,Humans,Incidence,Trypanosomiasis, African,Trypanosomiasis, African: drug therapy,Trypanosomiasis, African: epidemiology,Trypanosomiasis, African: prevention {\&} control,World Health Organization},
    month = {jan},
    number = {2},
    pages = {e1007},
    pmid = {21364972},
    publisher = {Public Library of Science},
    title = {{The human African trypanosomiasis control and surveillance programme of the World Health Organization 2000-2009: the way forward.}},
    url = {http://dx.plos.org/10.1371/journal.pntd.0001007},
    volume = {5},
    year = {2011}
    }
  • [DOI] Simarro Pere P, Diarra Abdoulaye, {Ruiz Postigo} Jose A, Franco José R, Jannin Jean G. The Human African Trypanosomiasis Control and Surveillance Programme of the World Health Organization 2000–2009: The Way Forward. Plos neglected tropical diseases 2011;5(2):e1007.
    [Bibtex]
    @article{Simarro2011b,
    author = {Simarro, Pere P. and Diarra, Abdoulaye and {Ruiz Postigo}, Jose A. and Franco, Jos{\'{e}} R. and Jannin, Jean G.},
    doi = {10.1371/journal.pntd.0001007},
    editor = {Aksoy, Serap},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Simarro et al. - 2011 - The Human African Trypanosomiasis Control and Surveillance Programme of the World Health Organization 2000–2009.pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS Neglected Tropical Diseases},
    month = {feb},
    number = {2},
    pages = {e1007},
    publisher = {Public Library of Science},
    title = {{The Human African Trypanosomiasis Control and Surveillance Programme of the World Health Organization 2000–2009: The Way Forward}},
    url = {http://dx.plos.org/10.1371/journal.pntd.0001007},
    volume = {5},
    year = {2011}
    }
  • [DOI] Simarro Pere P, Cecchi Giuliano, Franco José R, Paone Massimo, Diarra Abdoulaye, Priotto Gerardo, Mattioli Raffaele C, Jannin Jean G. Monitoring the Progress towards the Elimination of Gambiense Human African Trypanosomiasis. Plos neglected tropical diseases 2015;9(6):e0003785.
    [Bibtex]
    @article{Simarro2015,
    author = {Simarro, Pere P. and Cecchi, Giuliano and Franco, Jos{\'{e}} R. and Paone, Massimo and Diarra, Abdoulaye and Priotto, Gerardo and Mattioli, Raffaele C. and Jannin, Jean G.},
    doi = {10.1371/journal.pntd.0003785},
    editor = {Matovu, Enock},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Simarro et al. - 2015 - Monitoring the Progress towards the Elimination of Gambiense Human African Trypanosomiasis.pdf:pdf},
    issn = {1935-2735},
    journal = {PLOS Neglected Tropical Diseases},
    month = {jun},
    number = {6},
    pages = {e0003785},
    publisher = {Public Library of Science},
    title = {{Monitoring the Progress towards the Elimination of Gambiense Human African Trypanosomiasis}},
    url = {http://dx.plos.org/10.1371/journal.pntd.0003785},
    volume = {9},
    year = {2015}
    }
  • [DOI] Simarro Pere P, Cecchi Giuliano, Franco José R, Paone Massimo, Diarra Abdoulaye, Ruiz-Postigo José Antonio, Fèvre Eric M, Mattioli Raffaele C, Jannin Jean G. Estimating and mapping the population at risk of sleeping sickness.. Plos neglected tropical diseases 2012;6(10):e1859.
    [Bibtex]
    @article{Simarro2012,
    abstract = {BACKGROUND: Human African trypanosomiasis (HAT), also known as sleeping sickness, persists as a public health problem in several sub-Saharan countries. Evidence-based, spatially explicit estimates of population at risk are needed to inform planning and implementation of field interventions, monitor disease trends, raise awareness and support advocacy. Comprehensive, geo-referenced epidemiological records from HAT-affected countries were combined with human population layers to map five categories of risk, ranging from "very high" to "very low," and to estimate the corresponding at-risk population.
    RESULTS: Approximately 70 million people distributed over a surface of 1.55 million km(2) are estimated to be at different levels of risk of contracting HAT. Trypanosoma brucei gambiense accounts for 82.2{\%} of the population at risk, the remaining 17.8{\%} being at risk of infection from T. b. rhodesiense. Twenty-one million people live in areas classified as moderate to very high risk, where more than 1 HAT case per 10,000 inhabitants per annum is reported.
    DISCUSSION: Updated estimates of the population at risk of sleeping sickness were made, based on quantitative information on the reported cases and the geographic distribution of human population. Due to substantial methodological differences, it is not possible to make direct comparisons with previous figures for at-risk population. By contrast, it will be possible to explore trends in the future. The presented maps of different HAT risk levels will help to develop site-specific strategies for control and surveillance, and to monitor progress achieved by ongoing efforts aimed at the elimination of sleeping sickness.},
    author = {Simarro, Pere P and Cecchi, Giuliano and Franco, Jos{\'{e}} R and Paone, Massimo and Diarra, Abdoulaye and Ruiz-Postigo, Jos{\'{e}} Antonio and F{\`{e}}vre, Eric M and Mattioli, Raffaele C and Jannin, Jean G},
    doi = {10.1371/journal.pntd.0001859},
    editor = {Ndung'u, Joseph Mathu},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Simarro et al. - 2012 - Estimating and mapping the population at risk of sleeping sickness(2).pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    keywords = {Africa South of the Sahara,Epidemiologic Methods,Humans,Risk Assessment,Trypanosoma brucei gambiense,Trypanosoma brucei gambiense: pathogenicity,Trypanosomiasis, African,Trypanosomiasis, African: epidemiology},
    month = {jan},
    number = {10},
    pages = {e1859},
    pmid = {23145192},
    publisher = {Public Library of Science},
    title = {{Estimating and mapping the population at risk of sleeping sickness.}},
    url = {http://dx.plos.org/10.1371/journal.pntd.0001859},
    volume = {6},
    year = {2012}
    }
  • [DOI] Simarro Pere P, Cecchi Giuliano, Paone Massimo, Franco José R, Diarra Abdoulaye, Ruiz José A, Fèvre Eric M, Courtin Fabrice, Mattioli Raffaele C, Jannin Jean G. The Atlas of human African trypanosomiasis: a contribution to global mapping of neglected tropical diseases.. International journal of health geographics 2010;9(1):57.
    [Bibtex]
    @article{Simarro2010,
    abstract = {BACKGROUND: Following World Health Assembly resolutions 50.36 in 1997 and 56.7 in 2003, the World Health Organization (WHO) committed itself to supporting human African trypanosomiasis (HAT)-endemic countries in their efforts to remove the disease as a public health problem. Mapping the distribution of HAT in time and space has a pivotal role to play if this objective is to be met. For this reason WHO launched the HAT Atlas initiative, jointly implemented with the Food and Agriculture Organization of the United Nations, in the framework of the Programme Against African Trypanosomosis.
    RESULTS: The distribution of HAT is presented for 23 out of 25 sub-Saharan countries having reported on the status of sleeping sickness in the period 2000-2009. For the two remaining countries, i.e. Angola and the Democratic Republic of the Congo, data processing is ongoing. Reports by National Sleeping Sickness Control Programmes (NSSCPs), Non-Governmental Organizations (NGOs) and Research Institutes were collated and the relevant epidemiological data were entered in a database, thus incorporating (i) the results of active screening of over 2.2 million people, and (ii) cases detected in health care facilities engaged in passive surveillance. A total of over 42 000 cases of HAT and 6 000 different localities were included in the database. Various sources of geographic coordinates were used to locate the villages of epidemiological interest. The resulting average mapping accuracy is estimated at 900 m.
    CONCLUSIONS: Full involvement of NSSCPs, NGOs and Research Institutes in building the Atlas of HAT contributes to the efficiency of the mapping process and it assures both the quality of the collated information and the accuracy of the outputs. Although efforts are still needed to reduce the number of undetected and unreported cases, the comprehensive, village-level mapping of HAT control activities over a ten-year period ensures a detailed and reliable representation of the known geographic distribution of the disease. Not only does the Atlas serve research and advocacy, but, more importantly, it provides crucial evidence and a valuable tool for making informed decisions to plan and monitor the control of sleeping sickness.},
    author = {Simarro, Pere P and Cecchi, Giuliano and Paone, Massimo and Franco, Jos{\'{e}} R and Diarra, Abdoulaye and Ruiz, Jos{\'{e}} A and F{\`{e}}vre, Eric M and Courtin, Fabrice and Mattioli, Raffaele C and Jannin, Jean G},
    doi = {10.1186/1476-072X-9-57},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Simarro et al. - 2010 - The Atlas of human African trypanosomiasis a contribution to global mapping of neglected tropical diseases(2).pdf:pdf},
    issn = {1476-072X},
    journal = {International journal of health geographics},
    keywords = {Africa South of the Sahara,Africa South of the Sahara: epidemiology,Animals,Atlases as Topic,Cluster Analysis,Humans,Insect Vectors,Insect Vectors: parasitology,Population Surveillance,Population Surveillance: methods,Trypanosoma brucei gambiense,Trypanosoma brucei gambiense: pathogenicity,Trypanosoma brucei rhodesiense,Trypanosoma brucei rhodesiense: pathogenicity,Trypanosomiasis, African,Trypanosomiasis, African: epidemiology,Trypanosomiasis, African: parasitology,Trypanosomiasis, African: transmission,Tsetse Flies,Tsetse Flies: parasitology},
    month = {jan},
    number = {1},
    pages = {57},
    pmid = {21040555},
    title = {{The Atlas of human African trypanosomiasis: a contribution to global mapping of neglected tropical diseases.}},
    url = {http://www.ij-healthgeographics.com/content/9/1/57},
    volume = {9},
    year = {2010}
    }
  • [DOI] Simo Gustave, Rayaisse Jean Baptiste. Challenges facing the elimination of sleeping sickness in west and central Africa: sustainable control of animal trypanosomiasis as an indispensable approach to achieve the goal.. Parasites & vectors 2015;8(1):640.
    [Bibtex]
    @article{Simo2015,
    abstract = {African trypanosomiases are infectious diseases caused by trypanosomes. African animal trypanosomiasis (AAT) remains an important threat for livestock production in some affected areas whereas human African trypanosomiasis (HAT) is targeted for elimination in 2020. In West and Central Africa, it has been shown that the parasites causing these diseases can coexist in the same tsetse fly or the same animal. In such complex settings, the control of these diseases must be put in the general context of trypanosomiasis control or "one health" concept where the coordination of control operations will be beneficial for both diseases. In this context, implementing control activities on AAT will help to sustain HAT control. It will also have a positive impact on animal health and economic development of the regions. The training of inhabitants on how to implement and sustain vector control tools will enable a long-term sustainability of control operations that will lead to the elimination of HAT and AAT.},
    author = {Simo, Gustave and Rayaisse, Jean Baptiste},
    doi = {10.1186/s13071-015-1254-y},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Simo, Rayaisse - 2015 - Challenges facing the elimination of sleeping sickness in west and central Africa sustainable control of anim(2).pdf:pdf},
    issn = {1756-3305},
    journal = {Parasites {\&} vectors},
    month = {jan},
    number = {1},
    pages = {640},
    pmid = {26671582},
    title = {{Challenges facing the elimination of sleeping sickness in west and central Africa: sustainable control of animal trypanosomiasis as an indispensable approach to achieve the goal.}},
    url = {http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4681034{\&}tool=pmcentrez{\&}rendertype=abstract},
    volume = {8},
    year = {2015}
    }
  • [DOI] Tirados Inaki, Esterhuizen Johan, Kovacic Vanja, Mangwiro Clement TN, Vale Glyn A, Hastings Ian, Solano Philippe, Lehane Michael J, Torr Steve J. Tsetse Control and Gambian Sleeping Sickness; Implications for Control Strategy.. Plos neglected tropical diseases 2015;9(8):e0003822.
    [Bibtex]
    @article{Tirados2015,
    abstract = {BACKGROUND: Gambian sleeping sickness (human African trypanosomiasis, HAT) outbreaks are brought under control by case detection and treatment although it is recognised that this typically only reaches about 75{\%} of the population. Vector control is capable of completely interrupting HAT transmission but is not used because it is considered too expensive and difficult to organise in resource-poor settings. We conducted a full scale field trial of a refined vector control technology to determine its utility in control of Gambian HAT.
    METHODS AND FINDINGS: The major vector of Gambian HAT is the tsetse fly Glossina fuscipes which lives in the humid zone immediately adjacent to water bodies. From a series of preliminary trials we determined the number of tiny targets required to reduce G. fuscipes populations by more than 90{\%}. Using these data for model calibration we predicted we needed a target density of 20 per linear km of river in riverine savannah to achieve {\textgreater}90{\%} tsetse control. We then carried out a full scale, 500 km2 field trial covering two HAT foci in Northern Uganda to determine the efficacy of tiny targets (overall target density 5.7/km2). In 12 months, tsetse populations declined by more than 90{\%}. As a guide we used a published HAT transmission model and calculated that a 72{\%} reduction in tsetse population is required to stop transmission in those settings.
    INTERPRETATION: The Ugandan census suggests population density in the HAT foci is approximately 500 per km2. The estimated cost for a single round of active case detection (excluding treatment), covering 80{\%} of the population, is US{\$}433,333 (WHO figures). One year of vector control organised within the country, which can completely stop HAT transmission, would cost US{\$}42,700. The case for adding this method of vector control to case detection and treatment is strong. We outline how such a component could be organised.},
    author = {Tirados, Inaki and Esterhuizen, Johan and Kovacic, Vanja and Mangwiro, T N Clement and Vale, Glyn A and Hastings, Ian and Solano, Philippe and Lehane, Michael J and Torr, Steve J},
    doi = {10.1371/journal.pntd.0003822},
    file = {:C$\backslash$:/Users/michelle.stanton/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tirados et al. - 2015 - Tsetse Control and Gambian Sleeping Sickness Implications for Control Strategy.pdf:pdf},
    issn = {1935-2735},
    journal = {PLoS neglected tropical diseases},
    month = {aug},
    number = {8},
    pages = {e0003822},
    pmid = {26267814},
    publisher = {Public Library of Science},
    title = {{Tsetse Control and Gambian Sleeping Sickness; Implications for Control Strategy.}},
    url = {http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003822},
    volume = {9},
    year = {2015}
    }
  • [DOI] Wamwiri Florence Njeri, Changasi Robert Emojong, Wamwiri Florence Njeri, Changasi Robert Emojong. Tsetse Flies (Glossina) as Vectors of Human African Trypanosomiasis: A Review. Biomed research international 2016;2016:1-8.
    [Bibtex]
    @article{Wamwiri2016a,
    abstract = {Human African Trypanosomiasis (HAT) transmitted by the tsetse fly continues to be a public health issue, despite more than a century of research. There are two types of the disease, the chronic gambiense and the acute rhodesiense -HAT. Fly abundance and distribution have been affected by changes in land-use patterns and climate. However, disease transmission still continues. Here, we review some aspects of HAT ecoepidemiology in the context of altered infestation patterns and maintenance of the transmission cycle as well as emerging options in disease and vector control.},
    author = {Wamwiri, Florence Njeri and Changasi, Robert Emojong and Wamwiri, Florence Njeri and Changasi, Robert Emojong},
    doi = {10.1155/2016/6201350},
    issn = {2314-6133},
    journal = {BioMed Research International},
    pages = {1--8},
    publisher = {Hindawi Publishing Corporation},
    title = {{Tsetse Flies (Glossina) as Vectors of Human African Trypanosomiasis: A Review}},
    url = {http://www.hindawi.com/journals/bmri/2016/6201350/},
    volume = {2016},
    year = {2016}
    }